Which drugs help prevent sudden cardiac arrest in diabetes patients?
A leading cause of death in industrialised countries is sudden cardiac arrest, a condition that occurs when the heart’s electrical system malfunctions and the heart abruptly stops beating normally. In Europe, only around 8 % of people who suffer cardiac arrest outside the hospital setting survive. For people with diabetes, the risk of OHCA is higher. Focusing on diabetic patients, scientists from the University of Amsterdam and Utrecht University in the Netherlands compared common medications used for diabetes mellitus type 2 to find out if any led to a reduced risk of OHCA. Conducted with support from the EU-funded ESCAPE-NET project, the study found that sulfonylurea drugs are associated with a lower risk of OHCA than the antidiabetic drug metformin. “More research is needed to confirm the findings and patients with diabetes should not change or stop taking their medication,” observed ESCAPE-NET project leader and study co-author Dr Hanno Tan of the University of Amsterdam in a press release posted on the ‘European Society of Cardiology’ website. The research findings have been published in the ‘British Journal of Clinical Pharmacology’. For the purposes of the study, 219 patients with diabetes who suffered a cardiac arrest between 2005 and 2011 were compared with 697 control diabetic patients who experienced no cardiac arrest. Each OHCA case was matched based on age and sex with up to five non-OHCA controls who were alive on the date the case OHCA occurred. In both the case and control groups, the average age was around 71 years and more than 75 % of the patients were male. The OHCA data for the population‐based case control study was taken from the Amsterdam Resuscitation Studies (ARREST) registry. Data on controls was obtained from the PHARMO Database Network that contains drug‐dispensing records from community pharmacies.
The findings
The research team found that sulfonylurea drugs taken alone or in combination with metformin were linked to a lower risk of OHCA than treatment solely with metformin. “Metformin is typically a first-line treatment which, if ineffective, is followed by a sulfonylurea drug – suggesting that patients taking metformin had less advanced diabetes,” explained Dr Tan. “This provides additional support for the notion that sulfonylurea drugs reduce cardiac arrest risk.” Individual sulfonylurea drugs – glibenclamide, gliclazide, glimepiride and tolbutamide – were also compared with each other. Gliclazide, but not glibenclamide, was found to have a lower risk of OHCA than glimepiride. For tolbutamide, the association with lower OHCA risk wasn’t statistically significant. “The results of this study bring us a step closer towards understanding how to avoid sudden cardiac arrest in the community. However, we need more studies to confirm our finding. One day we hope to personalise prevention by prescribing drugs according to an individual’s genetic make-up,” Dr Tan concluded. ESCAPE-NET (European Sudden Cardiac Arrest network: towards Prevention, Education and NEw Treatment) brings together 18 academic, research, public and commercial partners from 10 European countries. Its aim is to fully exploit available research data in order to improve sudden cardiac arrest prevention and treatment. For more information, please see: ESCAPE-NET project website
Keywords
ESCAPE-NET, cardiac arrest, out-of-hospital cardiac arrest, OHCA, diabetes, sulfonylurea, metformin